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Can Workers’ Comp Deny a Claim?

Alvine Weidenaar, Worker’s Compensation

If your compensation claim has ever been denied, you should know that you don’t have to accept it and do nothing about it. While the Worker’s Compensation system is a bit complex, making an appeal about this decision is within your rights.

You deserve to know if your claims were rightly or wrongly denied.

What Is Workers’ Compensation?

Worker’s Compensation is a mandatory system approved by the government which offers monetary benefits to workers injured or disabled in service. This claim is beneficial to both the employer and the employee because once an employee accepts the Compensation, he is unable to sue the employer for negligence. 

There are some reasons why an insurer can deny your compensation claims:

The injury did not happen at your workplace: 

So let’s say you stepped out of the office for a while to get some food across the road and got hit by a car or got involved in an accident. Can you still file for workers’ claim comp?


Well, it becomes a completely different case if the accident happened when your boss sent you to get food.  

Compensation benefits are only applicable to injuries or illnesses sustained from duties performed in the course of your employment.

If the injury resulted from a pre-existing condition:

In a situation where you already had a particular condition, and then it intensified during the course of your work, your company may deny being the cause of the injury. 

No witness of the accident:

The insurers believe that if an injury happened in a workspace, then some employees should have been there to witness something as serious as that. In the case where you do not have any witnesses to support your claims, your claims might not proceed.

Failure to report the incident immediately:

If you delay in reporting your incident, then there are chances of rejection of your claims. The insurers believe that as soon as the incident occurs, it should be reported, or else they will assume that it was not a serious case. They might come up with a claim that it was a minor case that intensified after another activity outside the workplace.

There is a set deadline for reporting every work-related injury case in every state. If you miss the deadline, then your claim might not make it.

Evidence of the presence of alcohol or drugs in your system:

If, for some reason, the employee has to take a medical test report after the accident and a percentage of drugs or alcohol is in the body system of the employee, chances are the claims may not proceed.

In some states, no employer can carry out a drug test on an employee after he sustains an injury, except there is a possibility that drug use or intoxication was an active cause of this incident. 

The ignorance of this law might cause the employee to lose the case that he should have won.

Inconsistent accident report:

If your accident narrative to the supervisor and the narrative to your doctor is different, then you might have some problems getting your claims approved. Glitches in accident story consistencies can be suspicious and lead to rejection.

You filed the claim after the company fired you:

If you are only bringing your claims after a lay-off, Insurers assume it is a revenge claim. This is why it is important to waste no time immediately you sustain an injury from work. Go immediately and file the case.

How To Prevent Your Claims From Denial

Educating yourself about these laws can be very helpful. The major reason most people get their claims denied is ignorance. A lot of people do not know their rights, so they are unable to enforce them or at least find someone to help them. If you stay informed, you know what to do to ensure the approval of your claims.

What To Do If Your Claims Are Denied

For a denied claim, the first thing you should do is find out why. You need to know if the claims are rightly or wrongly denied as this is a determining factor of in the next step. 

If you find out that your claims are wrongly denied, then you need to make an appeal. At this point, it might be wise to invite a Worker’s Comp lawyer to take over from here.

The appeal process is a long and complex one, and for a Favorable outcome, you need strong legal counsel. 

You need a lawyer when:

  • Your employer denies the claim.
  • Your employer or the insurance company denies the incident happens at work. 
  • The case is being prolonged.
  • The insurance company has refused to foot the bills for your injury. 
  • Your employer revenges against you by either firing you or tampering with your work hours.
  • When you need to negotiate with your insurer.

Why Should You Use Our Lawyers?

Our professionals at the Alvine Law Firm, LLP have years of experience up their sleeves. We pride ourselves in our ability to deliver the best results at negotiating tables. We have handled all kinds of workers’ comp claims issues and always come out victorious.

We specialize in personal injury issues. Our long streak of success has improved our credibility, making us more reliable to our clients. 

Who better to handle your workers compensation issues than our esteemed lawyers? We do not underrate any case irrespective of the details. We are committed to giving you justice. Call us today to tell us about your case, and we will get to work immediately.

Get the help you need today!

Our legal team’s expertise allows us to quickly evaluate your claim to allow you to get back to living your life.